Attempts to manage endometriosis fall into three categories:
1. Medical (medications)
2. Surgical (involving an operation)
3. Complementary (physical therapy, psychology, complementary medicine, etc.)
You should discuss the differences in the treatments with your doctor before starting a treatment. There are advantages and disadvantages to all the types of treatments and you may need to have several treatments of different types before finding the right combination for you.
It is EFHOU’s non-medical opinion that the limited benefits associated with these drugs do not equal the costs. There are currently no drugs on the market that treat endometriosis or prevent endometriosis from occurring. However, some drugs may provide symptom management.
These can be divided into hormonal and non-hormonal interventions.
Some hormonal therapies include the oral contraceptive pill, Depo Provera shot, IUD, and GnRH agonists/antagonists. While birth control pills and IUDs may be used long-term, some medications, such as GnRH modulators can be used for short periods only due to their side-effect profiles. These are powerful medications and can have significant, long-term consequences on the body with no long-term benefits. Non-hormonal medications include pain-relieving medications such as non-steroidal anti-inflammatories and strong pain relievers. These medications are designed to relieve the pain that can be associated with endometriosis.
Again, there are no drugs that treat or prevent endometriosis, and the disease may progress despite symptom relief.
These include laparoscopy or laparotomy.
A laparotomy is where the abdomen is opened through a large incision either through a bikini line or occasionally through a lengthwise cut from the belly button down to the pubic area.
In contrast, a laparoscopy requires only a few small incisions.
Surgery for endometriosis is usually performed by laparoscopy because it causes less scarring, less pain, less time in the hospital, and allows the surgeon to better visualize the areas where endometriosis can grow.
A skilled surgeon should rarely need to perform a laparotomy, but your doctor will inform you of the chances of this prior to your surgery.
Not all surgeries or surgeons are created equal. Most OBGYNs burn endometriotic lesions through ablation or fulguration. This only burns the surface, leaving behind the bulk of the lesion underneath. Endometriosis excision specialists, however, fully excise the disease. This leads to significantly improved outcomes. Learn more about excision here.
Patients are sometimes misled to believe that the only long-term solution is a hysterectomy. This is not true. This ongoing misconception is responsible for over 100,000 needless hysterectomies each year in the United States.
Although excision surgery is considered the cornerstone of care, this option may not be financially available to everyone. Additionally, long-term endometriosis pain can result in maladaptive changes throughout the body and central nervous system that may not be resolved through surgery alone. Using other health professionals such as physical therapists, acupuncturists, nutritionists, or psychologists can be helpful for some people with endometriosis. You should discuss these treatments with your doctor before starting them.
Pelvic Floor Physical Therapy
Endometriosis is a systemic disease impacting the whole body. The body reflexively reacts to pain by tensing muscles at or near the pain. Over time, this results in distress and dysfunction, locking muscles in a shortened, tight, and painful state. This, itself, becomes a pain generator layered on top of endometriosis pain.
Pelvic floor physical therapists can use techniques to ease muscle tension, retrain and correctly strengthen muscles, mobilize organs and scar tissue, release restrictions, improve alignment, and enhance blood flow. They can help retrain bladder, bowel, and sexual function. Over time, the changes brought about by PT can also help quiet an irritated central nervous system.
Many patients suffering from endometriosis have undoubtedly been told “It’s all in your head.” Therefore, the idea of going to therapy for endo can be pretty off-putting. That said, it is not a therapist’s job to decide if you are physically sick or not. It is a therapist’s job to help you manage your struggles, and endometriosis comes with many. Many people with endo suffer from anxiety and depression as a result of the pain, isolation, and losses caused by endometriosis. A therapist who specialises in pain management can help by teaching specific strategies that have been found to be helpful in coping with chronic pain, as well as teaching strategies to manage associated stresses. For therapy to be helpful, you must be open to the process. If it does not feel like a therapist is a good fit for you, don’t give up! it is ok to seek out another provider.
Some people find that making dietary changes can help reduce endometriosis symptoms. There is no set “endo diet”, but some benefit from a diet with a low inflammatory load. This may mean decreasing or cutting out soy, dairy, gluten, refined sugars, and caffeine. Experimentation may be required to determine what works for you. Always consult your doctor before making any major dietary changes.